Lab Instead of Clinical Judgement? Measuring CRP in Respiratory Tract Infections in Family Practice
DOI: 10.3238/zfa.2018.0276-0281german translation / full article
Background: Since February 2018, family physicians and pediatricians in Saxony-Anhalt, who participate in the family doctor-centred health care, can additionally bill a rapid CRP-test for patients with upper respiratory infections. The aim is to reduce unnecessary antibiotic prescriptions. In this study we investigated the scientific basis of this intervention.Methods: We searched the Cochrane Library and PubMed for randomized controlled trials (RCTs) and systematic reviews with the following research question: does measurement of CRP in primary care patients with upper respiratory infection compared to usual care reduce antibiotic prescription rates? In addition, the guidelines of the German College of General Practitioners and Family Physicians (DEGAM) regarding „earache“, „rhinosinusitis“ and „sore throat“ were analyzed with regard to recommendations for CRP measurement and prescription of antibiotics.Results: There is moderate evidence for the reduction of antibiotic prescription rates for upper and lower respiratory infections by quantitative CRP measurement. The magnitude of the effect is inconsistent. The studies differ in terms of disease spectrum, doctors‘ training and CRP limit values. CRP measurement does not affect the clinical course. In the three DEGAM guidelines, measurement of CRP and the use of antibiotics are recommended only in special circumstances.Conclusions: The compensation for CRP measurement introduced in Saxony-Anhalt should be clarified as follows: use of quantitative CRP tests for upper and lower respiratory tract infections, combined with training of physicians in guideline-based diagnosis and therapy and especially in CRP limits for children and adults. A scientific evaluation of this intervention seems necessary.